Académique Documents
Professionnel Documents
Culture Documents
1. LOSS
A. Actual loss
i. Any loss of a person or object that can no longer been felt, heard, known, or
experienced by an individual. (Death, amputation, Sensory loss,
independence, divorce)
B. Perceived loss
i. Any loss uniquely defined by the client. (confidence, self-esteem, group
status)
C.Maturational loss
D. Situational loss
i. Any sudden unpredictable event (hurricane Katrina, recessional job loss,
chronic illness; financial loss, security, family role. Hospitalization; privacy,
modesty)
2. Grief
ii. Anger: pt. may begin to recognize loss; they begin to strike out at
caregivers. Pt. is angry about loss. May become accusatory, demanding. Keep
in mind this is not personal or directed towards you.
iii. Bargaining: Let’s make a deal. Trying to barter for more time. Postponing
awareness of dealing with loss.
iv. Depression: will see all classic symptoms of depression. They begin to realize
what all the loss will entail. They realize the total impact of the loss. May
exhibit suicidal thoughts or tendencies.
v. Acceptance: pt. begins to accept loss for what it is. Begin to look toward
future and accept loss for what it is. Less introverted, participate in more
activities in environments.
iii. Fear of the Unknown: death is an unknown state. We all have beliefs and
faiths but really don’t know. Fear about what will happen to your families.
iv. Fear of Loss of Self-concept and Body Integrity: Procedures that change body
appearance or function.
ii. Fear of Loss of Self Control: similar to above. Cannot control emotions,
cannot control environment. Loss of independence.
iii. Fear of Suffering and Pain: Emotional pain, physical pain, social
withdrawal, altercation of relationships. Fear family will suffer.
F. School Aged
i. More curios about biological side of death. May see death as punishment.
May take blame for death. May see some cognitive changes.
G. Adolescent
i. Understand death as permanent. May somatosize.
H. Human development
i. Age of patient. Developmental stage they are in.
I. Psychosocial perspectives
i. Age, gender, status, race, intellect.
J. Socioeconomic status
i. May interfere with obtaining medical help, counseling, etc…
K. Personal relationships
i. Mother, father, child, sibling vs. second cousin or friend.
N.Spiritual beliefs
i. Finding comfort in a higher power, certain rituals or rights associated with the
death.
P. Grief reactions
i. Assess how the pt is reacting not how you think they should be reacting.
R. End-of-life decisions
i. Decisions that relate to what that pt wants with regards to end of life care.
ii. Nurse should try to discuss this with pt. when possible.
S. Nurse’s experiences
i. We each have to look inside when dealing with terminal patients. Need to
examine our own ideas on death and dying b/c it will affect care we give.
ii. Need to look out for our own emotional well being as well.
iii. Need to deal with personal phobias of death. Cannot put own personal
feelings above that of the client!
T. Client expectations
i. “what can I do to help you?”
6. Nursing Diagnoses
U.Anticipatory grieving
V. Dysfunctional grieving
W. Hopelessness
X. Powerlessness
Y. Spiritual distress
7. Planning
Z. Goals and outcomes
1. Perform rites
EE. Assist with mobilizing other support systems that are important to the
client
i. Help promote healthy grief resolution. Help them move through the process
and adjust to loss. Deal with stressors in their life; make health care
decisions at this time.
GG. Therapeutic communication: open ended statements, will learn more in
Mod. E. No topic that a dying client wants to talk about is off limits. CLIENT
NEEDS THAT OUTLET!
HH. Promoting hope: can be an energizing resource for anyone dealing with
loss. Have cheerful attitude, encourage positive coping mechanisms, offering
info about illnesses to dispel misconceptions, using external resources.
1. Sensory barriers
i. Clarifies: answer any questions that may not have come up when the
initial diagnosis was given.
ii. Listens
vi. Is available
2. Planning
14. Assist Family to Grieve
YY. Provide daily updates: Do not deliver bad news when only one family
member is present
ZZ. Resources
15. Choices of Care Setting
JJJ.Increase in temperature
KKK. Skin changes-cold, clammy: can become diaphoretic though.
NNN. “Death rattle”: a lot of congestion in chest that moves around and
rattles as they are breathing.
RRR. Tissue and Organ Donation: will want to talk to pt. and pt. family about
organ donations prior to death.
i. Heart, liver, kidney, lung, pancreas
ii. Non-vitals that can be harvested: long bones, corneas, middle ear bones, skin
iii. If pt is donor keep cardiovascular systems going. Call donor bank rep.
i. Nurse’s responsibility
1. Check orders
VVV. Family/sig others: allow them to say goodbye and have closure.
AAAA. Environment: try to have nice clean environment for family to view
body after death.
BBBB. Viewing time: give family time to say goodbye. Do not rush family!
21. After the family leaves...
ii. May have to wrap body certain way, go by policy for prep to travel to
morgue.